直视支架象鼻手术治疗右位主动脉弓合并Kommerell憩室的疗效分析  

Efficacy of stented elephant trunk procedure for right-sided aortic arch with Kommerell's diverticulum

作　　者：钟永亮[1] 唐兵 陈苏伟 葛翼鹏[1] 胡海瓯[1] 乔志钰[1] 里程楠[1] 刘永民[1] 朱俊明[1] ZHONG Yongliang;TANG Bing;CHEN Suwei;GE Yipeng;HU Hai'ou;QIAO Zhiyu;LI Chengnan;LIU Yongmin;ZHU Junming(Department of Cardiovascular Surgery and Aortic Surgery Center,Beijing Anzhen Hospital of Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Aortic Disease Center,Beijing,100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心血管外科/主动脉外科中心,北京市心肺血管疾病研究所,北京市大血管疾病诊疗研究中心,北京100029

出　　处：《中国胸心血管外科临床杂志》2024年第7期1020-1026,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：北京安贞医院种子基金(AZ2023-ZZ-03);北京市科协青年人才托举工程(BYESS2024335);北京市科技计划项目(Z191100006619093;Z191100006619094);国家自然科学基金(81970393;81900325)。

摘　　要：目的 总结直视支架象鼻手术治疗右位主动脉弓(right-sided aortic arch,RAA)合并Kommerell憩室(Kommerell's diverticulum,KD)的临床经验及早中期结果。方法 回顾性纳入2013年4月—2020年7月在首都医科大学附属北京安贞医院心血管外科接受直视支架象鼻手术治疗RAA合并KD患者。所有患者均经胸骨正中切口、中低温停循环联合选择性脑灌注下手术。结果 共纳入8例患者,其中男7例、女1例,年龄(51.88±9.61)岁。所有患者术前均合并KD动脉瘤及迷走左锁骨下动脉,其中同时合并急性Stanford B型主动脉夹层1例、主动脉弓假性动脉瘤1例、急性B型主动脉壁内血肿2例、冠状动脉粥样硬化性心脏病1例。术中均重建左锁骨下动脉;同期行冠状动脉旁路移植术1例。全组平均手术时间(6.25±1.16)h,体外循环时间(157.75±40.07)min,主动脉阻断时间(77.75±33.10)min,选择性脑灌注时间(28.50±5.55)min。全组无术中死亡病例。术后早期死亡1例。术后随访(3.58±2.08)年,随访率100.00%。随访期间无死亡。1例随访发现近端吻合口漏持续存在,随访期间无主动脉扩张及气管、食管压迫症状,未行再干预。其余患者主动脉重塑良好、KD瘤腔完全血栓化,无主动脉事件及气管、食管压迫症状。结论 对于合适的RAA合并KD患者,直视支架象鼻手术是一种安全可行的治疗方案,并可获得满意的早中期临床结果。Objective To summarize our experience and the early and midterm outcomes of stented elephant trunk procedure for right-sided aortic arch(RAA) with Kommerell's diverticulum(KD).Methods From April 2013 to July 2020,patients with RAA and KD who underwent stented elephant trunk procedure at our center were collected.Surgery was performed under moderate hypothermic circulatory arrest combined with selective antegrade cerebral perfusion via median sternotomy.Results A total of 8 patients were included,including 7 males and 1 female with a mean age of 51.88±9.61 years.All patients had an aneurysmal KD and aberrant left subclavian artery.Preoperative comorbidities included acute Stanford type B aortic dissection in 1 patient,aortic arch pseudoaneurysm in 1 patient,acute type B intramural hematoma in 2 patients,and coronary artery disease in 1 patient.Concomitant procedures included reconstruction of the left subclavian artery in all patients and coronary artery bypass grafting in 1 patient.The mean time of operation,cardiopulmonary bypass,aortic cross-clamping,and selective cerebral perfusion was 6.25±1.16 h,157.75±40.07 min,77.75±33.10 min,and 28.50±5.55 min,respectively.No intraoperative death occurred.There was 1 inhospital death.Follow-up was completed in all patients with a mean period of 3.58±2.08 years.No late death occurred.A persistent anastomotic leak of the proximal arch was detected in 1 patient,but reintervention was not performed because neither aortic dilatation nor symptoms of tracheal and esophageal compression were observed during the follow-up.The remaining 6 patients showed positive aortic remodeling with complete thrombosis of the aneurysmal KD,and neither aortic event nor tracheal and esophageal compression occurred.Conclusion Stented elephant trunk procedure is a safe and feasible technique for selected patients with RAA and KD,which can achieve favorable early and midterm outcomes.

关 键 词：直视支架象鼻手术 右位主动脉弓 Kommerell憩室 迷走左锁骨下动脉 主动脉瘤 

分 类 号：R654.3[医药卫生—外科学]